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The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Sorrentino: On today's episode of The Clinical Excellence Podcast, we have Dr. Bree Andrews talking about the Clinical Excellence Scholars Track or CEST program at the University of Chicago designed for undergraduate students to gain key skills and experience needed to become a physician.
[00:00:21] Dr. Andrews: Yeah, this is a neat new field and I think we're trying to get away from demanding more of the individual. We aren't going to say, "You have to do more yoga and you have to come to work more well," what we're saying instead is, "We'd really like the organization and the place you work to feel well to you, to feel like you have meaning in your work," and that's especially poignant in healthcare because if we do that, we are also transmitting that to our patients.
[00:00:50] Dr. Sorrentino: We are back with another episode of The Clinical Excellence Podcast sponsored by the Bucksbaum Institute. I'm Dr. Matthew Sorrentino, co-host for the podcast. During this podcast, we discuss, dissect, and promote clinical excellence. We review research pertinent to clinical excellence, we invite experts to discuss topics that often challenge the physician-patient relationship, and we host conversations between patients and doctors.
Today I'm joined by Dr. Bree Andrews. Dr. Andrews is an associate professor of pediatrics in the section of neonatology. She specializes in complex care of infants in the neonatal intensive care unit. Dr. Andrews has also been named the inaugural Chief Wellness and Vitality Officer for physicians at the University of Chicago. The Chief Wellness and Vitality Officer for physicians is charged with assessing the state of wellness in the organization and implementing programs that will improve ease of practice, collegiality and resilience, while addressing burnout and inefficiencies using state-of-the-art methods, thoughtful approaches, and emerging best practices. Dr. Andrews, welcome to the podcast.
[00:02:00] Dr. Andrews: Thank you. This is wonderful.
[00:02:02] Dr. Sorrentino: So I thought we'd start from the very beginning. Um, we know that it's a long road to being a physician. Students start with pre-medical studies, many of them take years off to do research, then medical school, then internship, residency programs, fellowships before ultimately becoming a doctor that's practicing in medicine.
Um, can you think about some of the key characteristics that in those early stages, those early years in pre-medical years, what are the characteristics, what should we be looking for in students that would make a really good doctor?
[00:02:36] Dr. Andrews: I'm glad you asked me that. I think, um, what I'm noticing makes fantastic students is exposure, exposure to clinical care, complex decision making, the range of the human experience in medicine. And I think, um, that really comes from kind of getting to a clinic, getting to the hospital, volunteering with organizations that serve people with medical conditions because I think once you start with that compassion piece and that exposure, the rest of it...
[00:03:07] Dr. Sorrentino: Sure.
[00:03:07] Dr. Andrews: ...comes more naturally.
[00:03:08] Dr. Sorrentino: Yep, yep. And how can we actually expose students in a period of time where they're so science driven, they've got to get all their science, you know, courses underway? How can we expose them to the compassionate side of medicine?
[00:03:26] Dr. Andrews: First of all, making sure their workloads are reasonable in undergraduate studies...
[00:03:30] Dr. Sorrentino: Yeah.
[00:03:30] Dr. Andrews: ...because I think when I think back about what's meaningful about my training, it's not that I actually learned biochemistry three times.
[00:03:38] Dr. Sorrentino: Right.
[00:03:38] Dr. Andrews: And most people don't ask me about biochemical pathways, maybe thank God.
[00:03:43] Dr. Sorrentino: Yes.
[00:03:44] Dr. Andrews: But I think, you know, really making sure that piece is manageable so they can get out to clinical spaces, into spaces where they can see patients with different problems.
Um, you know, we here at the University of Chicago do that through shadowing in our clinics, and I always say to our young folks, "You know, come with me, come see rounds, see how the whole team works together." I'm in the neonatal intensive care unit, which at first sounds scary, but in fact, we take care of mothers and babies.
[00:04:11] Dr. Sorrentino: Right.
[00:04:11] Dr. Andrews: And most of them are thriving and improving. And so I can take that group with me to see those babies making recovery and they can see how our technology works, and they can see some of the delicate conversations we have at the bedside all while we're making physiology decisions every moment. And so, I think that's really special to have those folks with us and they're doing incredible things. Some of their work is way ahead of what we were exposed to in terms of the science at the undergraduate level. So they teach me all sorts of things about their training now.
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[00:04:44] Dr. Sorrentino: Sure. Right. So can this elusive thing, the doctor-patient relationship, can it actually be taught or is it still mostly, as you've pointed out, it's really observation, shadowing, mentorship?
[00:04:58] Dr. Andrews: I guess it probably can be taught, you know, it's a challenging question, but I think we should aim to do both, to do exposure and then to kind of tease apart the parts that make it special. I always tell my trainees, I was just telling a group of them now, I tell folks, "Look quickly at the medical record. I'll tell you what you need to know. Get in, knee to knee, we can do that again after Covid, get knee to knee with a parent and hold the baby in your lap, hold the child in your lap or tickle their toes and talk to them about what's happening. You can tell a lot about a child's needs, their medical needs, and their family's needs if you can just speak to them and watch them." And if they're too focused on the record or the labs or the list of conditions a child has had, it's hard to drill down on how to make decisions for that patient.
Knee to knee, close communication is really special. I had an undergraduate student with me recently and the mother had a new baby, probably a four-month-old, former 28 week premature, so born three months early, so about a month old. And the baby was fussy and the mother said, "But I need to use the bathroom." And I said, "Well, would you let me hold the baby?" And so I rocked the baby and put the baby to sleep on the exam table. And the students said to me, "You're good with babies." And I said, "Yeah, not only can I treat them for complex medical conditions, I can put them to sleep." And he said, "And the mom got to go to the washroom." And I said, "Right," which she also needed.
[00:06:30] Dr. Sorrentino: Yes.
[00:06:30] Dr. Andrews: Uh, but I think it was good for him to see that not only am I ordering tests and making clinical decisions, but I'm rocking the baby to sleep if that's what's needed.
[00:06:39] Dr. Sorrentino: So you have that direct contact, that direct approach with the baby, with the mom. Yeah.
[00:06:43] Dr. Andrews: Yeah. And I think he could see just those early steps of, "Oh, I could rock the baby." Right?
[00:06:48] Dr. Sorrentino: Right, right.
[00:06:48] Dr. Andrews: And that is something an undergraduate could do or a first year medical student could do.
[00:06:54] Dr. Sorrentino: Now I know that medical school can sometimes be daunting to students, all the prerequisites, the science, how much is the non-science approach in undergraduate education, the humanities, the areas of medicine that maybe do go more into the personal relationship, how important is that our students have that as part of their background to becoming good physicians?
[00:07:20] Dr. Andrews: I wish it was required.
[00:07:21] Dr. Sorrentino: Yeah.
[00:07:22] Dr. Andrews: You know, I mean, and it is to some extent in that I think more schools are recognizing that there's a wide range of training that can help. I've been impressed over the years how many undergraduate institutions are also formalizing degrees in public health...
[00:07:39] Dr. Sorrentino: Mm-hmm.
[00:07:40] Dr. Andrews: ...in biomedical ethics and other domains that we used to not see as often, and those folks come out, I think, with a really good repertoire of skills.
[00:07:49] Dr. Sorrentino: Yes. Yeah. Yeah. Well, I know here at the University of Chicago, there's a unique program in the undergraduate program that was co-sponsored by the Bucksbaum Institute, developed a program that was called The Clinical Excellence Program for the undergraduate students who are interested in medicine. Um, can you describe a little bit about how this program works? What makes this program unique and how does this really find and foster that right type of student for medicine?
[00:08:19] Dr. Andrews: Great question. I've been fortunate to lead in this group for a number of years with three other faculty, and each of us has a cohort of about 25 students and we work with them, um, one-on-one or in a group, but together as that group three times a year.
[00:08:37] Dr. Sorrentino: Mm-hmm.
[00:08:38] Dr. Andrews: And we really talk through what are the next steps for their career trajectories. I usually ask each of my students, "You know what? What's the most exciting thing you did that's related to your possible career in medicine? And then what are the pebbles in your shoes? What's causing you some trouble?"
[00:08:56] Dr. Sorrentino: Yeah.
[00:08:57] Dr. Andrews: "And kind of what can I do to support you?" And amazingly, I think they're very excited to just be together. They have common problems and most of them are manageable. And I think just having some of that time to sit together and talk about how it all unfolds is really special actually, because a lot of their teachers are really in the one domain they're in, right?
[00:09:22] Dr. Sorrentino: Yes. Right.
[00:09:23] Dr. Andrews: They're teaching chemistry. We get the recommendations from their teachers...
[00:09:27] Dr. Sorrentino: Okay.
[00:09:28] Dr. Andrews: ...coming into the program, and they don't say the kinds of things that I'm that interested in, to be truthful, because they're not used to assessing kind of the broad range of skills that we're looking for. Um, but we nurture these folks and we ask them to call on us for anything they need. I've been impressed with a number of letters of recommendation I've written for CEST students coming out of our program when I wasn't their main teacher, but I could kind of think through, oh, this is the transformation they've made. And a lot of them have slightly different priorities. One of my students during Covid, I said to them, "What are you all doing? How are you all surviving this?" And this one guy said, "I went to learn R by myself." And I was like, "You can, you learned R by yourself? Like it would take, you know, 15 people to teach me R in a short period of time." But he said, "My lab said if I just brought that back, I could do these things while we were remote." And I thought that's really amazing! And that's a pretty, you know, that's a technical skill, but we had people who went home and volunteered to do something new, or helped someone else in the group and it was... They're a fantastic group of kids, students, I should say, but...
[00:10:35] Dr. Sorrentino: Students, right?
[00:10:36] Dr. Andrews: Yeah. Young adults.
[00:10:37] Dr. Sorrentino: How long does the program go for? Does it start in the second year, third year undergraduate?
[00:10:41] Dr. Andrews: We've evolved the program over time, but it used to start in the second year, sometimes we're now starting in the third year just because of some of the limitations with shadowing and volunteer work, but we require volunteer work and an interview process in the beginning, and then they're really with us two full years.
[00:10:59] Dr. Sorrentino: And how much shadowing does each student get a chance to do?
[00:11:03] Dr. Andrews: On average, it seems like they do about, you know, one long clinic every two weeks maybe.
[00:11:10] Dr. Sorrentino: Wow, that's a lot. Yeah.
[00:11:11] Dr. Andrews: Yeah. I would say so. And to me they're shadowing like any other clinician in my group.
[00:11:16] Dr. Sorrentino: Yeah.
[00:11:17] Dr. Andrews: You know, any resident, any fellow, they're getting a similar amount of exposure.
[00:11:22] Dr. Sorrentino: And how much is the student just watching what happens and how much is their kind of debriefing afterwards where the faculty member in your case, with your students, do you get to sit down and show them how this relationship worked? How the interaction between the physician and the patient went because it's not just the medical information that was given, but it's watching those patient cues and those physician cues and how they interact, and are you able to go over that with the student and show them how this relationship really works?
[00:11:56] Dr. Andrews: Oh, yeah. They sit with us, you know, in our workroom and talk through both the medical, you know, pieces like what is this disease and how do you treat it but also how do you help a family that has this problem, you know, with housing or with food insecurity? And I think that piece is really special 'cause that's part of medicine now too.
[00:12:17] Dr. Sorrentino: And what is some of the feedback that you've gotten from the students? Do they feel that this is a helpful program in their decision to become a physician? Does it better solidify, "Yes, this is what I really want to do"?
[00:12:29] Dr. Andrews: I think they need this because most of them say, "Oh, this is what I was hoping it was going to be like, I didn't know how all those other parts were going work, all the organic chemistry and physics that I needed to do, but this is what I was kind of dreaming of or aiming for." I think also we have a lot of college students and I was one that was included who don't have family in medicine.
[00:12:52] Dr. Sorrentino: Yeah. Yeah.
[00:12:53] Dr. Andrews: So they don't have any framing for what this might be like as a career. And I think it's great to have them, you know, with us and partnering with us.
[00:13:01] Dr. Sorrentino: Yeah. I think it's great. I look back to my decision to go into medicine. Nobody in my family was in medicine, I knew nothing about it. And I was a science major in undergrad, like so many of my peers, and it wasn't until my senior year in college that one of my, um, advisors said, "Well, why don't you think about medicine?" And to tell you the truth, I told him, I hadn't thought about it at all. It wasn't anything I'd ever been exposed to. And the first time I was ever exposed to a hospital or to a patient was when I fortunately got into medical school and was on that first rounds. And boy, I wish I would've seen it before and seen what I was getting into. Now, of course, I loved it and that was great, but I think having that exposure at a younger age so that a student really knows this is what they wanna do is a special way to do it.
[00:13:45] Dr. Andrews: Yeah, and I think that medicine has a strong culture, but we nurture our young learners. And so I think, you know, for them to see that, you know, you can be the least experienced one, but you're part of the team is really special. Our, you know, our patients say, "Oh, I really enjoyed meeting your young person or your," you know, they call them young doctors, but they know that they're training, but I just think it's dear, you know, that they're starting to get that identity, you know, kind of in their hearts to be in medicine and in the medical field.
[00:14:16] Dr. Sorrentino: I've noticed that too how patients really like to have trainees. Sometimes they go out of their way to make them welcome and to, you know, kind of nurture them and mentor them along. It's really great to see when I've got some young students and young residents in with me, it's really...
[00:14:31] Dr. Andrews: Yeah, and I ask them, I say, "Please tell, you know, the student today, your journey with your child in the medical intensive care unit and explain to them what you went through and what you were thinking," and they love to tell those stories because it's also, you know, a story of survivorship and of um, you know, they can teach them that journey 'cause those students haven't heard that journey yet.
[00:14:53] Dr. Sorrentino: And the patient, or in this case, the patient's mom or father gets to articulate and tell their story, it helps them, I'm sure, it's a great way of letting that tension out and talking about it and bringing it out in the forefront, even if you're talking to a student.
[00:15:08] Dr. Andrews: Yeah, exactly right.
[00:15:09] Dr. Sorrentino: Yep. Well, you wear another hat as well, this title of Chief Wellness and Vitality Officer is a great title and it's really amazing how, um, long this process is to become a physician, how much stress there is. Covid added a whole 'nother stress in the last three years on top of everybody. And, um, how do we think about that? How do we think about wellness of our physicians, of our trainees, of our staff, for that matter? And tell me a little bit about your concept of this and your thought and what you'd really like to accomplish as being a wellness officer.
[00:15:46] Dr. Andrews: Yeah, this is a neat new field, I'm glad to be part of it, and I think we're trying to get away in this field from demanding more of the individual. You know, we're saying, you know, we aren't going to say, "You have to do more yoga and you have to come to work more well," what we're saying instead is, "We'd really like the organization and the place you work to feel well to you, to feel like you have meaning in your work, to feel like there's efficiency in your work, that you're appreciated, that we have gratitude for your work." And that's especially poignant in healthcare because if we do that, we are also transmitting that to our patients, right? We're asking our patients to be well themselves. And if we can be well, we can do that better and that's, you know, that makes us a very special workforce. Uh, I was just with the surgeon general today and we talked about that, that the healthcare sector has the really important space of keeping people well and keeping each other well, and I think that that makes it even more fun.
So for me, I'm trying to, you know, get out to each department in the hospital and find out what their unique challenges are, but also what makes them great. We love to be innovative at the University of Chicago, so we want to see our people continue to innovate and to have all the tools they need to do that. And I think that's one really special place for wellness, is to allow employees and allow our physicians to grow their own identity and to do exactly what they want to do here. I always say, I want our physicians to do their next best work with us.
[00:17:20] Dr. Sorrentino: Right, yeah.
[00:17:20] Dr. Andrews: And I want, you know, all the people that I work with, I want to be with them for a long time. So that's my mission, that's my charge. So far, it's been amazingly good. There are a lot of people who've been doing this work before I took this position, and so I have gratitude to them for all they've done trying to, you know, help their local folks, you know, be well and to mitigate burnout, you know, which is the buzzword.
[00:17:47] Dr. Sorrentino: Right.
[00:17:48] Dr. Andrews: But yeah, so far so good. I love it.
[00:17:50] Dr. Sorrentino: What about at the student level? I would think that learning how to care for yourself and learning wellness really has to start at a very early age. If you are taught in undergraduate medical school, you just have to keep working harder and harder and harder to get all those A's to be able to get to the next step, you put all that wellness thing on the back-burner. Are there initiatives, programs that you know of that are at the medical school level or even at the undergraduate level to help people from the very beginning in their career to keep this at the forefront?
[00:18:23] Dr. Andrews: Yeah, I think there are a great number of programs around this. I think the first is, you know, asking each student and each medical student, what matters to you.
[00:18:33] Dr. Sorrentino: Yes.
[00:18:33] Dr. Andrews: You know, I think that's important for all of us who work with others is to say what matters to you, how do you want to do it? Because otherwise it feels very prescribed, you have to do this and this and this. And what we really want is our students and our trainees to develop excellence, and that actually makes them feel good too. The number of trainees that I've met with, and undergraduates included, where I can identify better than they can why they're special, and it's because they're asked to do so many things well that they don't always... They can't always see their unique talents. And that's what makes our organizations phenomenal is that we have this range of people that work with us, including students and trainees and then attendings and senior attendings, but that each person brings something excellent to the table.
So, you know, I think that that's where we can really nurture them. A lot of folks, undergraduates especially, and trainees need some coaching around this.
[00:19:32] Dr. Sorrentino: Yep. Yep.
[00:19:33] Dr. Andrews: And that's one thing we're doing at Pritzker Medical School is offering some coaching around who do you want to be? What matters to you? How do we keep that in mind? That's the most important thing. You know, we can manage all... We recruit bright people so we can manage all the other pieces, right?
[00:19:49] Dr. Sorrentino: Yeah, yeah.
[00:19:49] Dr. Andrews: Um, but if we can keep people ignited to do the work they want to do, I think we can be quite successful.
[00:19:57] Dr. Sorrentino: So many students that I talk to enter medicine with this sense of altruism, you know, they really want to help people. They're going into medicine because they feel they have something they can give. They really want to help people, and then we make them work really, really hard. And we burn that altruism out of them because they realize how much work they got to do, how much paperwork they got to do, how late their hours are, you know, how they miss their friends because they're always working in the ER or working in the hospital. Um, how do we bring that sense of altruism back? How do we bring that sense that these students had, that they really want to help people and make that exciting for them again?
[00:20:38] Dr. Andrews: That is the million-dollar question. Um, I think that really making efficient systems for them...
[00:20:46] Dr. Sorrentino: Mm-hmm.
[00:20:46] Dr. Andrews: ...to manage all those pieces that can be stressful.
[00:20:49] Dr. Sorrentino: Yeah.
[00:20:49] Dr. Andrews: I think we have to model wellness for them. We can't let ourselves be distressed, in my opinion. You know, just we have to show them this is the way kind of to make a healthy pathway for your career, but I think it is, I think it is possible, you know, to show them kind of the workplace of medicine 2.0, right? The non-distressed, the efficient, the fulfilled clinician again.
I talk a lot at the University of Chicago also about service.
[00:21:19] Dr. Sorrentino: Mm-hmm. Mm-hmm.
[00:21:20] Dr. Andrews: I think we're good at serving others. You know, we work in a poor community and a lot of us volunteer and that's another place where we can kind of show 'em those altruistic pieces where you're just giving, you're not, you know, in those arenas, you're not always having to do... You know, people are grateful to have you as their doctor or as their advocate and I think that's another way that we can support them.
[00:21:45] Dr. Sorrentino: Well, there's certainly a lot of rewards in medicine, I think that's what really helps us all going forward. And I know what influenced me were some of my mentors who every time I would round with them or shadow them, you can tell they loved what they were doing. And you know, if here's somebody who loves going to work every day, yeah, that's the type of job I want, one that I can love going to work every day.
[00:22:07] Dr. Andrews: Yeah. Well, and one thing we talked a little bit about is kind of the hierarchy of undergraduates, medical students, trainees and attendings, but the teams at the hospital are very special.
[00:22:21] Dr. Sorrentino: Yes.
[00:22:22] Dr. Andrews: You know, I work in a big group. We have 200 nurses in our unit, and they know me and I know them. Right? And I think showing our students that they come and they work in a team environment, a lot of times you can do more for your team than you can do for yourself, and our work products are better because of those teams. It's almost like, you know, belonging to a sports team.
[00:22:43] Dr. Sorrentino: Yes.
[00:22:43] Dr. Andrews: You know, the win is a collective win, it's not an individual win. And I think that's something that we can show them and makes it quite special and less individualistic than some of that early training, you know, that they need.
[00:22:57] Dr. Sorrentino: Right, right. Well, I think it's really clear that what makes a great physician really starts when they're in their early training in those young years. And so it's really great to see that there's programs that are targeted to students in the undergraduate and that the medical school are thinking about these, and the fact that wellness and burnout is being talked about through all these different levels so that we can keep a healthy physician for us, but you know, happy physicians 'cause happy physicians make happy patients.
[00:23:27] Dr. Andrews: I hope so.
[00:23:27] Dr. Sorrentino: Yes. Great. Well, this has been fantastic. Thanks so much Dr. Andrews for joining us today. And all of those listening, thanks for joining us for this episode of The Clinical Excellence Podcast. We are sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas on the Bucksbaum Institute Twitter page.
And the music for this Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.